Why the Drastic Measures?

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On COVID-19 (Coronavirus Disease 2019), caused by the SARS-CoV-2 virus.

For up to date information:  https://www.cdc.gov/coronavirus/2019-ncov/summary.html

 

My friends, it’s been such a strange and surreal week.

I’m feeling so much more tense and agitated than I ever would have expected.

What keeps me really hopeful, though, is connection.

My colleagues and I have dug deep, cancelled our own spring break plans, and stood up in solidarity, ready to do what is needed to help one another take care of all of our patients.

Patients express empathy and patience for us their docs, which is so heartwarming.

They listen to my explanations for decisions to cancel gatherings and close schools. They understand when I describe what’s happening in Italy, and the difference between St. Louis and Philly during the 1918 Spanish flu pandemic.

Many are living the economic consequences of these decisions much more concretely and acutely than I, and their perspectives moderate my own.

I think the best thing we can all remember in the next several weeks is that we are all doing the best we can.  We are all in it together.

It’s stressful and scary for everybody, and sometimes we will lose our cool.

Now is the perfect time to call forth our best efforts at calm, compassion, empathy, and forgiveness.

And then wash our hands.

I share below a compilation of the media pieces that have helped me most in my communication with patients, with the most salient quotes below each respective link.  Maybe they will help you, too.

Onward.

 

https://www.wbur.org/news/2020/03/10/coronavirus-covid-19-massachusetts-hospital-capacity-ashish-jha?fbclid=IwAR3I0HXO028IGmJeyXV2ZhvEmUW56WO_EvE5ToOcjSsaeHkEGZxlS1vZQMg

“Some of the best epidemiologists in the world are estimating that between 40 and 70% of adults will end up getting an infection. Even if we begin with that low end of 40% of adults in Massachusetts, that’s 2 million people getting infected. If we take data from China that says 20% of people needed hospitalizations, that’s 400,000 hospitalizations. Even if we said ‘No, that’s too many, we can cut that in half,’ that’s 200,000 hospitalizations. At any given time in Massachusetts, we think there are [3,000 to] 4,000 hospital beds open at most … And so, if you start doing the numbers, you very quickly realize we do not have anywhere near capacity to take care of tens of thousands of people with [COVID-19] who might need hospitalization … But if we can spread that out over many, many, many months — ideally a year — then I think we have a shot of being able to take care of everybody who will need the care.”

How how does that happen, that it becomes spread out?

“So, what we know is that this idea that people talk about social distancing — this is why Harvard University today just canceled classes. In-person classes; we’re going online. In our offices, were now encouraging everybody to work remotely … Certainly all large gatherings should close.”

 

https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-cancel-everything/607675/

When the influenza epidemic of 1918 infected a quarter of the U.S. population, killing hundreds of thousands nationally and millions across the globe, seemingly small choices made the difference between life and death.

As the disease was spreading, Wilmer Krusen, Philadelphia’s health commissioner, allowed a huge parade to take place on September 28; some 200,000 people marched. In the following days and weeks, the bodies piled up in the city’s morgues. By the end of the season, 12,000 residents had died.

In St. Louis, a public-health commissioner named Max Starkloff decided to shut the city down. Ignoring the objections of influential businessmen, he closed the city’s schools, bars, cinemas, and sporting events. Thanks to his bold and unpopular actions, the per capita fatality rate in St. Louis was half that of Philadelphia. (In total, roughly 1,700 people died from influenza in St Louis.)

In the coming days, thousands of people across the country will face the choice between becoming a Wilmer Krusen or a Max Starkloff.

In the moment, it will seem easier to follow Krusen’s example. For a few days, while none of your peers are taking the same steps, moving classes online or canceling campaign events will seem profoundly odd. People are going to get angry. You will be ridiculed as an extremist or an alarmist. But it is still the right thing to do.

 

https://www.sciencemag.org/news/2020/03/does-closing-schools-slow-spread-novel-coronavirus?fbclid=IwAR0DZmornmQrYZJdgnz6ELAIl4cNocAl1nC6UExyZ4dIGByhaXrYV4PEcwo

When we engage in social distancing, it’s not so much that you don’t get infected yourself. The real advantage is that by removing yourself from circulation, you stop all the paths of this virus through you. You are doing a social service, you are helping the community. Employees who want to work from home [and are able to] can work from home.

 

Italy’s experience:

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

Two weeks ago, Italy had 322 confirmed cases of the coronavirus. At that point, doctors in the country’s hospitals could lavish significant attention on each stricken patient.

One week ago, Italy had 2,502 cases of the virus, which causes the disease known as COVID-19. At that point, doctors in the country’s hospitals could still perform the most lifesaving functions by artificially ventilating patients who experienced acute breathing difficulties.

Today, Italy has 10,149 cases of the coronavirus. There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.

Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow in these extraordinary circumstances. The document begins by likening the moral choices facing Italian doctors to the forms of wartime triage that are required in the field of “catastrophe medicine.” Instead of providing intensive care to all patients who need it, its authors suggest, it may become necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”

The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”

 

On taking the larger, community-centered view:

https://grownandflown.com/finest-hour-covid-19/?fbclid=IwAR34zisTQM3zb6JzF3u3obqL9EfkNEOwo7-x8R4QOciwJ36c8QA1ibCNeVY

Your losses are real. Your disappointments are real. Your hardships are real. I don’t mean to make light or to minimize the difficulty ahead for you, your family or community.

But this isn’t like other illnesses and we don’t get to act like it is. It’s more contagious, it’s more fatal—and most importantly, even if it can be managed. It can’t be managed at a massive scale—anywhere. We need this thing to move slowly enough for our collective national and worldwide medical systems to hold the very ill so that all of the very ill can get taken care of.

So what is our work? Yes, you need to wash your hands and stay home if you are sick. But the biggest work you can do is expand your heart and your mind to see yourself and see your family as part of a much bigger community that can have a massive—hugely massive—impact on the lives of other people.

You can help by canceling anything that requires a group gathering. You can help by not using the medical system unless it is urgent. You can help by staying home if you are sick. You can help by cooking or shopping or doing errands for a friend who needs to stay home. You can help by watching someone’s kid if they need to cover for someone else at work. You can help by ordering take-out from your local restaurants. Eat the food yourself or find someone who needs it. You can help by offering to help bring someone’s college student home or house out-of-town students if you have extra rooms. You can help by asking yourself, “What can I and my family do to help?” “What can we offer?” You can help by seeing yourself as part of something bigger than yourself.

 

Dr. Anthony Fauci on how to counsel patients, 13 min New England Journal of  Medicine podcast with transcript:

https://podcasts.jwatch.org/index.php/podcast-256-anthony-fauci-talking-with-patients-about-covid-19/2020/03/10/?query=RPF&fbclid=IwAR0gIzU7M5WOyC4964CbKnglcNw_wlSODvT6-KAYodWdKCMyrQWou2jyAK0

 

 

Sexism and Apologies 2020

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“If you say, ‘Yeah, there was sexism in this race,’ everyone says, ‘Whiner!’ If you say, ‘No, there was no sexism, about a bazillion women think, ‘What planet do you live on?’”

That is how Senator Elizabeth Warren answered a reporter when asked whether she thought gender played a role in her suspending her presidential campaign.  I recommend watching the whole video clip.  In case anyone wonders: if the question even needs to be asked, then yes, gender played a role.  But Senator Warren rightly called out the question for what it is: a trap for any woman running for high elected office.  Her statement summarizes it succinctly; she knows what’s what, and she names it without apology.

I was more upset than I expected when Aunt Eliz Crusader ended her campaign.   Megan Garber expressed the story of my profound disappointment eloquently in her piece for The Atlantic:  “America Punished Elizabeth Warren for her Competence”.  Basically she elaborates the apparently inevitable social equation for women:

Competent  +  Vocal  +  Unapologetic   =   “Strident”  +  “Shrill” +  “Condescending”

The past two weeks I have had a series of encounters wherein I find myself voicing opinions and positions more firmly than I might have in the past.  I feel confident and grounded in my knowledge and expertise.  I am professional and respectful.  I apologized for writing a long email, even though the words were necessary and clear.  My strong woman mentor reminded me to save apologies for when I actually commit a transgression.

What I have learned (perhaps again) in this time, however, is that relationship discord, even just the possibility of it, is what distresses me the most.  How will I be perceived for voicing my concerns, for advocating for my peers and teams?  How will a negative perception undermine my effectiveness?  Will it cost me my seat at this table or others?

Does any man ask himself these questions?

Given that I was already knee deep in vulnerability and self-doubt around these encounters, the Atlantic piece poked my fears and prodded them to the surface.  It shook me.  It also made me angry that here we still are, in 2020, unable to accept, let alone embrace, competent, vocal, and unapologetic women in leadership.  And it’s not just men; countless women also disavow their sisters.

I vented my disappointment on Facebook (of course):

“So it is down to three Old White Men.  Very disappointing.”

A friend tried to make light of the situation, pointing out that Donald Trump is the youngest of the three.  This attempt at levity (from the Right) felt like a nemesis rubbing salt in my fresh wound.  Twice I rebuffed; twice he persisted.  Finally I (voiced):  “I feel ignored and dismissed when I express distress and you make light of it.  Perhaps my distress is not clear to you, because you only know me through social media [we were friendly acquaintances in high school]; you may not know how upset I am.  But after two replies by me rejecting your attempt at humor, to have you schooling me [that humor is a ‘primary’ way] of dealing with [politics] just makes me more angry.”

Turns out he had mistyped; he’d meant to write that humor is one of his primary ways of coping with the absurdity of politics.  He apologized to me.  It felt sincere.  I was consoled, and I thanked him.

Competent and vocal.  Confident and unapologetic.  Respectful and humble.

We need all of these qualities and more to be true leaders.  Women, arguably, must work harder than our male counterparts to prove that we possess all of them.  Then we get punished when the proof proves irrefutable.  How sadly ironic.  The truth is we need many more of our leaders, men and women alike, to own, exude, and model these virtues.  The last two are not weak, though they may feel profoundly vulnerable, which is not the same thing.

I feel urgent impatience at the state of sexism in America.  But I know how to soothe and manage myself; I can reclaim the patient urgency of fierce optimism at my core.

I will persist.

Aunt Eliz has shown me how.

Caring for One Another

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Last Saturday a patient cared about me.

He had severe abdominal pain that had kept him up all night and he needed advice.  By the time we agreed on a plan he had apologized, at least three times, for ‘bugging’ me on the weekend.

I explained that it’s okay to ask for help on weekends. I’m happy to help if I can, and the relationship is the most meaningful part of my work.  I also thanked him for not abusing that relationship—for not taking me for granted, for seeing me not as a transactional service provider, but as a person with a life outside of work.

When we feel seen and appreciated, life is easier to take and we function better.

* * * * *

Recently I’m thinking about organizational values and mission statements.

For the most part I find them superficial and unhelpful, wordy and convoluted.

As I consider the team I have led the past two years, I feel proud that although we have not formally written mission or values statements, we are nonetheless clear on both.  We define them in succinct language, gauge how we manifest them through action, and reconcile behaviors, conflicts, and initiatives against them regularly.

Our values, collectively adopted one year ago:

  1. Fun, joy, creativity
  2. Collaboration and Connection
  3. Accountability
  4. Kindness and Compassion

Reviewing the list, I see that caring for one another serves as the foundation for this house.  This applies both to the team’s inner work, as well as anything facing outward toward patients.

It is of course our responsibility as professional caregivers to manage ourselves and show up our best for our patients.  I expect patients to treat our team with respect, but we should not necessarily feel entitled to their caring about us, per se.  It is our job to care for them; the relationship is inherently imbalanced in that way.  In order to do that well, we the team must also care for and support one another in service of our vocation.

So every once in a while, when a patient expresses genuine caring for me or a member of the team, in addition to appreciation for a job well done, it really brightens our day.  It keeps us going.  It makes all the unappreciative, and even abusive, encounters worth it.

Thus, we march on.  We remember why we do this work and we hold each other up.

* * * * *

Please know how much your expressions of affirmation matter to your medical team.

We’re all here caring for each other in this life.  The more we can remember that and act on it, the better off we will all be, no?

What Makes You a Leader?

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Is it your title?  Your reputation?
Is it your status?  Your paycheck?

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

This quote is attributed to John Quincy Adams, but there is apparently no evidence that he actually said it.  Dolly Parton, on the other hand, said,

“If your actions create a legacy that inspires others to dream more, learn more, do more and become more, then, you are an excellent leader.”

Your actions make you a leader.
Anybody can lead, as long as people are willing to follow.
So what makes people follow?

I think it’s actions grounded in:
Conviction
Authenticity
Openness
Inclusion
Transparency

Accountability
Resonance
Collaboration
Belonging
Integrity
Honesty
Humility
Consistency            …what else?

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So:  How do you lead others?  How aware are you of your leadership, day to day, moment to moment?  How intentional are you about it?
What do you lead others to and for?
What is your purpose in leading?
What is your goal for those you lead?

What is your goal for your cause?

What do you want from your followers?
What do they need from you?
How will you make it so that your cause outlives and continues to flourish without you?

Great leaders do not always know the answers to all of these questions.

But they ask and consider them, regularly, honestly, and humbly.

Attune and Differentiate:  One Week’s Synthesis

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Friends, don’t you just love when an idea you resonate with recurs in your consciousness from disparate sources in short order, further deepening its meaning?  I share three pieces with you this week, which all deepened my commitment to embracing the paradox of attunement and differentiation.

CO fall 2018

First, I listened again to Brené Brown’s Braving the Wilderness.  I highly recommend this book to help us all, conservatives and progressives alike, engage (not avoid) one another this election year with a lot more compassion, civility, and mutual respect.  Throughout the book Sister Brené shares personal stories as well as evidence from her research that define true belonging, which I think of as another expression for self-actualization and self-transcendence.  In her words:

True belonging requires us to believe in and belong to ourselves so fully that we can find sacredness in both being a part of something, and standing alone when necessary. But in a culture that’s rife with perfectionism and pleasing, and with the erosion of civility, it’s easy to stay quiet, hide in our ideological bunkers, or fit in rather than show up as our true selves and brave the wilderness of uncertainty and criticism.

Attune and differentiate:  these two practices are not only not mutually exclusive, they are essential and integral for whole person and societal health and well-being.  Read the book to adopt her four practices to advance true belonging, for yourself and for all of us:

  1. People Are Hard to Hate Close Up. Move In.
  2. Speak Truth to Bullshit. Be Civil.
  3. Hold Hands. With Strangers.
  4. Strong Back. Soft Front.  Wild Heart.

Sister columbines

Second, I met Massimo on Ozan’s last Inner Circle Zoom call.  He is a designer and facilitator from Italy—thank you again, Ozan, for connecting so many of us all around the world!  Massimo has launched a blog, which resonated with me because he also advocates finding your voice (differentiating) as well as finding a community of belonging (attunement) as a reason to write:

…Meet new people and to interact with them

Learning adventures can make you feel on a solitary path, too much unbalanced on the input, reading and digesting side without much interaction. Expand your network, look for more interactive exchanges with whom might provide an alternative, critical point of view compared to yours. Exposing your opinions leads self-selecting people to network and resonate with you. Find your tribe. We need many and none at the same time. You need different communities where to manifest and explore your interests. On the other hand, you need to better focus on creating those which are more fertile ground to nurture your continuously changing interests and aspirations.

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Third, I read David Brooks’s article in The New York Times on the ethos of Scandanavian education.  Eloquent as usual, he synthesizes a complex set of ideas into language we can all understand:

19th-century Nordic elites…realized that they were going to have to make lifelong learning a part of the natural fabric of society.

…(Their system) is devised to help (students) understand complex systems and see the relations between things — between self and society, between a community of relationships in a family and a town. 

…Nordic educators also worked hard to develop the student’s internal awareness. That is to say, they helped students see the forces always roiling inside the self — the emotions, cravings, wounds and desires. If you could see those forces and their interplay, as if from the outside, you could be their master and not their slave. 

…Their intuition was that as people grow, they have the ability to go through developmental phases, to see themselves and the world through ever more complex lenses. A young child may blindly obey authority — Mom, Dad, teacher. Then she internalizes and conforms to the norms of the group. Then she learns to create her own norms based on her own values. Then she learns to see herself as a node in a network of selves and thus learns mutuality and holistic thinking. [See Changing on the Job by Jennifer Garvey Berger for more on this theory of adult development.]

Scandanavians…have a distinctive sense of the relationship between personal freedom and communal responsibility.

(Meanwhile, in the United States…) If you have a thin educational system that does not help students see the webs of significance between people, does not even help students see how they see, you’re going to wind up with a society in which people can’t see through each other’s lenses.

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In 2020 more than ever, we need to cultivate much stronger relationship skills.  We must identify and honor our core values and stand up for them, even when attacked by those closest to us—perhaps even especially then.  How we honor our best selves determines how we honor others.  When we show up at our most honest and authentic, we can call forth the same in others to meet us.  We can relate as fellow humans, inextricably connected, mutually interdependent, and all in it together.  Once we realize this, we can know in our hearts that we truly belong to ourselves and to one another, and we can more easily get on with the world’s most important work—connecting humanity in health, safety, and love.

Be a Connecting Node

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How would you describe American political culture today?

What about the culture at your workplace?

In your family?

Are dissenting voices welcomed?  How do those in authority wield their power?  Do the led have a say in decisions and policies that affect them?  Are their needs and interests taken into account by those who lead?

What role do you play in each of these systems?  How do you contribute to the function, dysfunction, morale, and relationships in these interconnected, overlapping, inextricable and sometimes tenuous systems?

How much of these cultures do you own, do you take personal responsibility for?

I have written before about the interaction between a system and its individuals.  In each of the systems I name above—our nation, your workplace, your family—you are a single individual, a node [a point at which lines or pathways intersect or branch; a central or connecting point].  You are connected, directly and indirectly, to every other node in all of your systems.  Thus, you connect each of your overlapping systems to every other one.  So do I.  This is how we are all connected, every single one of us, and our planet.

Thus, what you do affects me, even if I have never met you, even if we live on different continents, in separate generations, speaking mutually unintelligible languages, and vice versa, for all of us.

Octavia Butler said it best:

All that you touch
You Change.
All that you Change
Changes you.
The only lasting truth
Is Change.
God
Is Change.

So how do you change what you touch?

Do you make it better than it was?  Does the change you make make you better in return?

If the only lasting truth is change, then what do we want tomorrow to look like?  What about next year?  What kind of world do we want our grandchildren and their grandchildren to inherit?

Are you a node that connects, using your power and love to thicken the ties between your adjacent nodes and systems, making them stronger and more resilient?  Who is healthier, stronger, and happier for you having touched them?  How have they then extended that health, strength and joy to others?  How have you resisted destructive forces and stood in the way of systems disintegration?  Whom have you protected?  What did it cost you, and what did you gain?  What have you earned?  How will you persist?  What and who hold you up?  On which nodes do you lean, from which do you draw strength, and how then do you pass that strength on?  How do you influence and co-create the culture around you this way?

Or are you a destructive, severing node?  How do you go around blowing up connections, weakening relationship infrastructures?  Maybe you don’t see it this way. Perhaps you see your work as culling, pruning, removing extraneous nodal debris, clearing the path for a more righteous supersystem to rise.  What does this cost you?  Is the benefit worth the price?  Who are your coconspirators in this effort?  How do they change you for your connections to them?  How do you expect your connections to other destructive nodes to evolve?  What is your impact on your systems cultures, being this way?

I suspect we all possess both poles of nodal potential.  Probably most of us go about our days in relative mindlessness, speaking and acting as our surroundings and culture dictate, by convention and custom.  We suppress the inner dissonance that arises when our personal instincts run counter to prevailing winds of rhetoric.  We fear losing connections if our personal nodal identity reflects a different light or sounds a different note from the collective thrum.  The status quo feels easier to uphold.

I posit to you today that our systems are disintegrating fast, eroded by myriad destructive nodes, spreading like slime mold on a global petri dish.  I argue that our collective political culture suffers much today from these destructive nodes, and connector nodes struggle to nurture ties and maintain relationships.  In such times, we may feel tempted to give in, to allow our inner rage monster to tantrum, to succumb to swelling, destructive, disconnecting culture.  Indeed, it is hard to resist.

And yet, we continue.  We march on.

Culture is created and maintained in each day to day interaction between all members of a system. Any individual may choose, at any time, to maintain the status quo or make a shift. It is the accumulation of multiple small shifts, simultaneously and in series, that moves a system to a new, improved state.  Each day we awaken, we have a choice—an infinite series of choices—to make a shift toward connecting and strengthening our intertwined systems.

Do not wait for someone else to go first.  Make the choice yourself, today, right now.  Be a connecting node.  Speak and act, post online, and show up in person, irrefutably, as a connector.  Make your touch productive and generative, inclusive, empowering, and communal.  See how this changes how others show up to you, and how that changes you for the better still.  Then watch the slime mold recede before your eyes as connector node energy amplifies and restores balance.

Slime molds recur.  Connecting nodes hold the line.  We need you.

This Year, Call Forth Our Best Selves

 

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I find myself even more self-conscious today than I did five years ago.  I hear fellow Asian-Americans express similar sentiments, especially as the coronavirus crisis escalates.  My friends and I haven’t experienced outright racism, but we’re on the lookout for it, as we see so many others deal with it every day.  Call it hypersensitivity if you wish.  But if you are white, please consider how your race provides you the unearned privilege of never (or at least seldom) having to question whether someone else’s negativity toward you is due to your skin color.

This election year, I’m deciding how I will be and how I will do.  I play with boundaries around media exposure, social media engagement, and conversations on politics.  I want to do it better than I did last time.  Soon after I started my Facebook page c.2008, I intended it to be a monument to my most positive tendencies.  That intention gave way to wrath and fury for much of 2016, ending regrettably in a couple of severed relationships.  At some point I reviewed my posts and found an alarming ratio of negative posts, mostly written during fits of impulsive rage.  That was a wake-up call.

By January 2017 I had recovered at least somewhat.  February 2017 brought a series of “Rules of Engagement” queries on this blog, which I am gratified to reread tonight.  These three years I have trained hard to approach all political conversations with more curiosity, generosity, and commitment to connection.  Some people and topics are still too sensitive to broach, but progress continues.  My training continues alongside my Better Angels tribe members.

I successfully moderated my media consumption these two weeks around impeachment.  I read Lamar Alexander’s statement 3 days ago and considered its purported rationale.  Part of it made sense to me, and still I’m unsatisfied with the whole situation, which I shared on Facebook.  My friends and I exchanged opinions and ideas civilly and respectfully, which I appreciate.

In the end, I believe engagement will be the solution.  In 2016 only 50% of eligible voters cast a ballot.  Of those, a little over half chose Hillary Clinton.  But it wasn’t enough for ‘my side.’  This year we must get the apathetic and disengaged back to the polls. We have nine months to rectify voter access, to connect with those on the fence and invite them down on the side of inclusion, equity, integrity, and respect for humanity.  If our opponents fling excrement, we cannot follow suit.  We must not become the shit-flinging adversaries we say we abhor—no matter which side we’re on.  We must speak from our highest core values, rather than to their lowest words and behaviors.  We must connect deeply with every person’s need to feel seen, heard, understood, accepted, and loved.  I have THE. HARDEST. time considering 45’s innate humanity.  But if I start there, I can handle any conversation with anyone else, and I show any ‘opponent’ why I am a worthy rival and not just an idiot enemy.  And I bring out the worthy rival ahead of the idiot enemy in them.

Well, at least this is the goal, the guiding light I intend to follow this year.  Surely I will fall under shadows sometimes.  But the more I manage to stay in the light, the less I will suffer and the less suffering I will inflict on others.  I intend to call forth my best self, for my sake the sake of all those around me.